Background: Hypertension control is a crucial measure to reduce cardiovascular (CV) risk, and blood
pressure (BP) treatment targets have been recently revised to address this issue. However, achieving the recommended
goal may be challenging.
Objective: We aimed to assess the prevalence of uncontrolled hypertension, according to the US hypertension
guidelines, among elderly participants in an Italian nationwide epidemiological survey, the relevant clinical correlates,
and the agreement with the application of the European guidelines.
Methods: Elderly (≥65y) volunteers enrolled in an Italian nationwide survey underwent BP measurement using
standard protocols. Uncontrolled hypertension was defined as BP≥130/80 mmHg. Agreement of this definition
with those from European guidelines (≥140/90 mmHg; ≥140/80 mmHg) was tested using Cohen’s kappa. Selfreported
information on modifiable/non-modifiable CV risk factors was also collected.
Results: Of the 13,162 treated hypertensive elderly, 69.8% had uncontrolled hypertension. They tended to be
overweight/obese men with diabetes. Overall agreement between US and European guidelines was poor to good
(κ = 0.289, p<0.001 and κ = 0.691, p<0.001 based on the 140/90 and 140/80 mmHg threshold, respectively).
Elderly participants with controlled hypertension were more likely to report a history of CV or chronic kidney
disease. No difference in lifestyle habits was observed by BP control status.
Conclusion: Real-world data identify limited concordance between guidelines in terms of BP target achievement
among older hypertensive Italians and highlights the need to spread awareness of the CV risk, especially in the
presence of diabetes and obesity.